Nutrition Management of Necrotizing Enterocolitis

Abstract

Necrotizing enterocolitis (NEC) is one of the most significant causes of morbidity and mortality among premature infants. The exact cause is considered multifactorial and related to gastrointestinal immaturity, inflammation and enteral feeding. The role of nutrition is vitally important in NEC. The main modifiable risk factor is the introduction and advancement of enteral feedings. After an infant has recovered from NEC, enteral feeds should be cautiously resumed to prevent injury from prolonged use of parenteral nutrition. The logistics of how, when, and what to feed are somewhat unclear and often depend on the severity of the disease. For patients with an enterostomy, refeeding the distal intestine with the small-intestinal ostomy output may improve bowel growth and prevent long-term complications.

Nutrition in Necrotizing Enterocolitis and Following Intestinal Resection

“…However, it has been shown that supplemental PN at NEC onset does not appear to significantly improve outcomes, with no decrease in the rate of surgical intervention or in-hospital mortality [41]. PN is discontinued once enteral feedings approach goal volumes [42].…”

“…The primary metabolic complication associated with PN is intestinal failure associated liver disease (IFALD), which is characterized by direct hyperbilirubinemia, elevated transaminases, and liver synthetic dysfunction [53]. Some modifications to PN can be made to reduce the risk for liver injury, such as not overfeeding and cycling infusions [42]. Improvement of cholestasis also depends on maintaining an appropriate protein-to-energy ratio in PN [79].…”

Supporting Optimal Growth in Infants with Chronic Conditions: How Are We Doing and What Can We Do?

“…Breast milk contains a variety of factors that may be protective against NEC, such as immunoglobulins, prebiotics, bioactive proteins, and growth factors. For patients requiring surgical intervention post-NEC, breast milk is preferred for enteral feeds after surgery; 9 surgery reported that infants with NEC received breast milk in only 7% of hospitalized days. 10 If breast milk is not available or the patient is intolerant to standard preterm formulas, hydrolyzed formulas (e.g., semielemental and amino acid based) may be used, but there is limited evidence on which type is best for infants recovering from NEC.…”

“…10 If breast milk is not available or the patient is intolerant to standard preterm formulas, hydrolyzed formulas (e.g., semielemental and amino acid based) may be used, but there is limited evidence on which type is best for infants recovering from NEC. 9,11 Feeding strategies should aim to support growth, encourage adaption, and prevent parenteral nutrition-associated liver disease, yet the perfect nutrition to support optimal growth may not always be clear. Although breast milk is recommended, breastfeeding may be very difficult due to stress, loss of confidence, and other negative psychological effects parents experience when their infant is hospitalized in the neonatal intensive care unit (NICU).…”

Packed Cell Transfusion and Feeding Tolerance in Well Preterm Infants: A Randomized Clinical Trial

“…So far, many risk factors have been identi ed for this disorder. Along with prematurity as the main risk factor, infection, in ammation, ischemia, feeding material, hyperviscosity is the other involved factors (6).…”